Granting another person access to our bodies – even taking parts away from that body – has the potential to bring about the most serious conflicts in our beliefs and values.If we may struggle to understand our own “autonomy”, and what it means to make autonomous decisions, then it seems to be an impossible task to presume to know what others believe and to decide with certainty how they would like their bodies to be dealt with.Rather than speculating about how people may feel about donation, we should be more open about the aspirations of the organ donation project – to foster a society where people want to donate because this could help others to continue living their lives. So, the best interventions would work even further upstream, increasing the true supply of eligible donors without regard to whether they consent. ... Wales' organ donation opt-out law has not increased donors .
In this simple example, we can see that autonomy represents a clear line flowing from my beliefs and values to my actions.But it’s not always so easy to identify our beliefs and values. Over the past 20 years, more than 85 amputees around the world have received a hand or bilateral hand transplant – including two adults and one child here at Penn Medicine and Children’s Hospital of Philadelphia (CHOP). Twenty-seven European countries have shifted from an “opt-in” organ donation system to an “opt-out” (or “presumed consent”). An opt-out organ donation register in England may not increase the number of organs because grieving relatives could be less sure what their loved ones had wanted, a study suggests. That said, there’s also the elephant in the room, which is whether everyone who could potentially benefit from a transplant ought to get one – for almost all those patients, the procedure would not meet conventional criteria for cost-effectiveness, but for one reason or another, we’re not currently at a place – as a society – where anyone is eager to say that more transplantation is a bad thing. But that is about to change. If the law can be so blatant in its presumption of altruism here, why not be as explicit in the legal basis of donation? In contrast, an opt-in system requires people to choose to be listed as a donor on the register. To overcome this, several countries have introduced an opt-out donor consent system. Improvements in how we manage brain-dead patients in the intensive care unit are one example of how we could increase the supply of eligible donors.Spain, which has an opt-out system and the highest rate of donations globally, has been successful because of a number of other factors, like expanded criteria for organ suitability and putting donor coordinators in each hospital to build relationships with potential donor’s families.A.
Kate O’Neill, MD, MTR, discusses the path that led her to develop the UNTIL trial and the significance of expanding the women’s options. In this regard, transplantation is not so unique.This blog is written and produced by Penn Medicine’s Department of Communications. Is it best to have a donation system where people have to opt in or opt out? First, the quality of the data supporting the idea that opt-out systems drive higher donation rates, is low. On paper, the opt-out system may seem like a good way for the United States to help drive up its poor numbers.
But the reality is that our decision-making process, our identities and sense of selves are far more complicated than that.Controlling our bodies, and stopping others from interfering with them, is central to our autonomy.